Try treatment for a change

October 22, 1993

A new report from the Abell Foundation highlights a glaring discrepancy in Baltimore city's approach to substance abuse: While the trends regarding drug use in the city are getting worse, spending on treatment programs is actually declining. Homelessness, overcrowded jails, crime, a continuing exodus of city residents to the suburbs, skyrocketing rates of HIV infection among intravenous drug abusers -- none of these urban ills can be addressed effectively without coming to grips with the city's substance abuse affliction.

Yet despite the connection between drug abuse and other social crises, the amount of government funds available for drug treatment in Baltimore declined from $16.3 million in 1991 to $14.8 million this year. Most of this money comes from federal and state sources. In fiscal year 1993, the city spent a scandalously low $155,000 of its own money for drug treatment efforts.

Given the city's financial woes, this might be understandable if there were a question about the effectiveness of treatment programs. But available data suggests treatment programs do work, although there is a crying need for more research on how well they work and which approaches benefit which types of abusers. To cite one compelling statistic, a 1989 study by the National Institute on Drug Abuse found that three to five years after treatment, the proportion of clients involved in predatory crimes ranged from one-third to one-half of pre-treatment levels. The authors of that study found the costs of drug abuse treatment are substantially recovered during the time a client is in treatment, and the savings to society later on represent a further return on the investment.

Yet in city debates about reducing crime we hear proposals for more police officers, not more expenditures for treatment. But already the city spends 50 times more on law-enforcement efforts to counter the plague of drug abuse than on treatment. That approach -- an echo of the national failure to win a law-enforcement victory in the war on drugs -- hasn't worked.

The city's small expenditures on treatment are surprising in light of Mayor Kurt L. Schmoke's high visibility on this issue. Almost alone among elected officials in this country, he dared several years ago to question the single-minded law-enforcement approach to controlling drug abuse. At first his ideas were dismissed out of hand. Now, however, cold reality is bringing his arguments renewed attention and a measure of respect.

Mayor Schmoke may not have a lot of dollars to throw at this problem. But he does have the power to set priorities within his own administration and to steer public debate. He needs to use both approaches if Baltimore is to reverse some dangerous trends in drug abuse.